The information in this program outline is provided by the program representative and edited by the CEBC staff. The Ecologically-Based Family Therapy (EBFT) program has been rated by the CEBC in the area of: Substance Abuse Treatment (Adolescent).

• Types of Maltreatment: Does not target any specific kind of maltreatment
• Target Population: Substance-abusing runaway adolescents (12-17) and their family members who are willing to have the adolescents live in their homes.

EBFT addresses multiple ecological systems and originated from the therapeutic work with substance-abusing adolescents who have run away from home. The treatment was developed to address immediate needs, to resolve the crisis of running away, and to facilitate emotional re-connection through communication and problem solving skills among family members. Family interaction is a necessary target of the therapeutic techniques. Therapy relies on understanding the individual, interpersonal, and environmental context as well as the unique resources and needs of the family and its members. The intervention includes family systems techniques such as reframes, relabels, and relational interpretations; communication skills training; and conflict resolution, but also therapeutic case management in which systems outside the family are directly targeted. The model includes 12 home-based (or office-based) family therapy sessions and 2-4 individual HIV prevention sessions.

Ecologically-Based Family Therapy (EBFT) is based on the recognition that substance use and related individual and family problems derive from many sources of influence and occur in the context of intra-, inter- and extra-personal systems. The following assumptions are made:

• The family is the primary system in a person’s life.
• All family members contribute to the development, maintenance, and resolution of problems among its members.
• Involvement of family members in the treatment of problems considered intrapersonal (e.g., substance use) will enhance positive individual, family, and social outcomes.
• Because the family and its members are nested within the larger social system, dysfunction in the primary (family) setting will impact functioning in other settings.
• Intervention does not focus solely on the individual, but on the social interactions among all participants that create the type of skill sets and emotional baseline for use in social interactions within and across systems.

EBFT is individually tailored to the needs of the family, as identified by assessing the family’s needs, strengths, and weaknesses.

Ecologically-Based Family Therapy (EBFT) was designed with a child component that addresses the following presenting problems and symptoms:

• Substance-abusing runaway behavior, sexual risk-taking, delinquency, and victim of abuse, trauma, or domestic violence.

Age range: 12 – 17

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Ecologically-Based Family Therapy (EBFT) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Substance-abusing runaway adolescent dependent, family conflict, disengagement between family members, abuse and neglect, parental substance use and parental depression.

Ecologically-Based Family Therapy (EBFT) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Recommended Intensity:

Average length of each session is 50 minutes. The model offers 12 weekly sessions of family therapy with additional 2-4 individual sessions for adolescent HIV prevention. If family members refuse to meet together for a family therapy session, one or two individual sessions can be conducted to address barriers and build trust before initiation of family sessions.

Recommended Duration:

3-6 months. However, the model is flexible to tolerate exceptions or crises.

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster Home
• Outpatient Clinic

Ecologically-Based Family Therapy (EBFT) includes a homework component:

Homework is integrated to facilitate the application of skills, which are developed in the therapy context, to daily life. In most cases, homework is comprised of interpersonal tasks, rather than paper and pencil tasks. The tasks are creatively designed with the input of the family and should be specific enough to the issues family is facing. It is important to check in with family members at the session following assignment of homework to discuss how the task was carried out, reactions to it, successes, and failures.

Ecologically-Based Family Therapy (EBFT) does not have materials available in a language other than English.

The typical resources for implementing the program are:

• Transportation to client home is needed if home-based therapy.
• Therapy rooms are needed if office-based therapy and bus passes or tokens to help facilitate session attendance.
• Audiotape recorders are needed for supervisory purposes for either type.
• Therapists are usually provided cell phones so that clients can easily access the therapist in times of crisis.
• In addition, the supervisor needs to have expertise in the social resources available in the social system to guide therapists in implementation of the case management component.

Level of education is less important than the ability to think relationally and systemically about the issues which families present. Therapists must be able to conceptualize the situation in terms of family relations which is central to the successful resolution of any presenting problem. In the research trials primarily Master's level counselors or family therapists were utilized.

In addition, the supervisors must be able to supervise systemic family therapy and have an understanding of the social systems, particularly juvenile justice, educational system, and health care, to guide therapists in case management. Supervisors must have outstanding skills to manage family crises and risks for the youth.

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:

• Natasha Slesnick
  nslesnick@ehe.osu.edu
  phone: (614) 247-8469

Training is obtained:

Training is obtained onsite or offsite.

Number of days/hours:

The duration and intensity of training depend on the therapists' competence to think relationally and systemically as well as their ability to implement therapeutic skills required in the intervention. For family therapists, onsite training includes a 2-day didactic training followed by weekly role-play practice until comfort and ease with the systemic procedures has been achieved. Also, ongoing audiotape review is standard. Trainings should allow enough time for practice of skills and role-plays.

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being